There is no question that this action is required from our governments if they intend on saving single-payer. So far, the response has been underwhelming, and the federal health minister claims that wait times are already being reduced. But it is obvious that, if wait times are not sufficiently reduced, two-tier is here. Otherwise, anyone frustrated by a wait will sue.

Single-payer lovers' greatest fear about two-tier is, and should be, that the existence of a private system allows for the further decline of the public system.

Consider the oft-mentioned example of MRI scan waiting lists. Imagine, in ten years time, a private system allowing citizens to jump the queue for MRIs. It is possible to envision the existence of the private system as an excuse to avoid further spending aimed at cutting the public system's waiting lists. People who are impatient will be told they have an option. This dynamic is what can slide the public system into second-rate status, and reduce it to being a choice only for those who can't afford better.

The additional risk is that, as more citizens acquire private plans, the political support for sufficiently funding the public system will be eroded.

Setting standards of care (including maximum waiting times) that must be attained, therefore, is not just necessary as a way of meeting constitutional requirements. It is also necessary as a way of protecting the public system from erosion by private competition.

Of course, standards of reasonable care were required even before this court ruling. Decency requires good health care for everyone.